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The present study deals with the influence of common affections of the liver and biliary tract upon the level of serum phosphatase activity in the adult. It is an analysis of our observations during the period 1933 to 1939 on those patients with involvement of the liver or biliary tract in whom the diagnosis could be proven by exploration or necropsy, or when insusceptible of proof (as in the hepatitides), could be established with reasonable certainty by clinical methods. Some 350 cases satisfied these criteria: 79 adults with proven obstruction of the common bile duct; 75 cases of hepatitis of indeterminate etiology ("catarrhal" jaundice); 39 cases of jaundice following exposure to known hepatotoxic drugs; 15 cases of hemolytic jaundice; 45 patients with proven cirrhosis of the liver, exclusive of biliary cirrhosis; 46 patients with proven neoplastic involvement of the liver; 10 patients with proven liver abscess; 10 cases of proven chronic passive congestion of the liver, without significant "cardiac" cirrhosis; and 29 cases of miscellaneous disorders of the liver or biliary tract. The data in 123 of these patients have been reported elsewhere (1). We record here observations made subsequent to that report, together with a study of the distribution of values in our total experience. On the basis of these empirical clinical data, we have attempted to define the clinical usefulness and limitations of the determination of serum phosphatase activity as applied to diseases of the liver and biliary tract. Three such applications of the method appear to be of promise: (1) as a supplementary aid to the clinical differential diagnosis of the several types of jaundice; (2) as an index to certain complications following surgical procedures on the biliary tract; (3) as a rela-

EFFECT OF DISEASE OF THE LIVER AND BILIARY TRACT UPON THE PHOSPHATASE ACTIVITY OF THE SERUM